States face swift deadline on health exchanges

Tuesday’s election ensures that President Barack Obama’s health care law marches on — but once again, its success is at the mercy of the states.

Whether the Affordable Care Act eventually manages to expand coverage to 30 million-plus people will largely depend on whether states opposing the massive overhaul will now accept the law’s inevitability and set a path for getting it up and running within their borders. And states are going to have some major deciding to do in a short amount of time.

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Eight days, to be exact.

By Nov. 16, states must tell the Obama administration whether they plan to run at least part of their own health insurance exchanges, new state-based marketplaces that will provide subsidies for low- and middle-income individuals and small businesses to purchase coverage. Eventually, states also will have to decide whether they’ll accept a larger expansion of Medicaid, which comes with a generous match from the federal government but still requires states to pony up some of their own money.

Carrying out the 2010 health care law successfully was always going to depend on states cooperating with the feds to get the law’s many pieces in place. But virtually all the Republican-led states have resisted committing to an exchange, hoping the Supreme Court or last night’s election would deliver a knockout blow to Obamacare.

That defeat never came, and GOP governors face a soul-searching decision they’ve seen coming since earlier this year: Do they take ownership of the law, although opposition has become a bedrock principle of Republican Party? In states that don’t create those exchanges, the feds will step in and run them. And that’s an arrangement that the Obama administration and health insurers who’ll sell in the new marketplaces aren’t particularly thrilled about.

Though most Republican states said they were waiting on election results to make their formal decision on exchanges, a number have been actively planning behind the scenes to run their own if options for the ACA’s demise were all exhausted.

“I think you’ll see a large number of states that have been waiting to begin to move more aggressively to implement,” said David Merritt, managing director at Leavitt Partners, which advises red states on exchange implementation.

So far, just 13 states and the District of Columbia have told HHS they plan to control their own exchange. In all, two-thirds of states could be ready to run at least part of an exchange when they open for enrollment next October, predicts Joel Ario, former HHS director of exchange planning. At least five GOP governors — including Texas’s Rick Perry, Florida’s Rick Scott and Louisiana’s Bobby Jindal — have absolutely rejected setting up their own exchange.

For those who do nothing and the Feds step in to set up an exchange, how quick before they start whining about “States Rights” and “Govt takeover” and “Govt over-reach”?

They need to grow up and face reality. ObamaCare passed in Congress, was signed by the President, survived Supreme Court challenges, and biggest of all, survived a national referendum and re-elected Obama.

As a result of the delayed implementation of the law, as many as 12 million people could be left waiting for coverage while being subjected to the individual mandate penalty. Perhaps if the Obama administration had pursued bipartisan compromise instead of ramming the law through Congress, states would be more inclined to participate in exchanges. That, and if HHS actually issued guidelines that states need to establish an exchange.